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Reducing Drug Prices for Seniors Act.
To amend title XVIII of the Social Security Act to require that coinsurance for drugs under Medicare part D be based on the drug's net price and not the drug's list price.
Summary
This bill amends Medicare Part D (prescription drug coverage for seniors) to require that coinsurance payments be calculated based on a drug's actual negotiated price rather than its list price, beginning January 1, 2026. The "net price" is defined as the negotiated price after any manufacturer-provided price concessions and rebates are applied, as reported in the Detailed DIR Report. The change applies to drugs covered under a plan's formulary that are subject to coinsurance (not flat copayments) for costs above the annual deductible and below the annual out-of-pocket threshold. When a drug's net price is lower than its list price, seniors would pay coinsurance based on the lower net price, reducing their out-of-pocket costs. The provision does not apply to certain drugs specified in existing Medicare Part D regulations.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
- Sen. Rosen, Jacky [D-NV] (D-NV)
1 cosponsor
- Sen. Cornyn, John [R-TX] (R-TX)
Actions (2)
- Jul 31, 2025 Read twice and referred to the Committee on Finance. · senate
- Jul 31, 2025 Introduced in Senate
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Full text
IN THE SENATE OF THE UNITED STATES
July 31, 2025
Ms. Rosen (for herself and Mr. Cornyn) introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to require that coinsurance for drugs under Medicare part D be based on the drug’s net price and not the drug’s list price.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Reducing Drug Prices for Seniors Act.”.
SEC. 2. REQUIRING THAT COINSURANCE FOR DRUGS UNDER MEDICARE PART D BE BASED ON THE DRUG’S NET PRICE AND NOT THE DRUG’S LIST PRICE.
Section 1860D-2 of the Social Security Act (42 U.S.C. 1395w-102) is amended—
(1) in subsection (b)—
(A) in paragraph (2)(A), in the matter preceding clause (i), by striking “and (9)” and inserting “,
(9), and (10)”; and
(B) by adding at the end the following new paragraph:
“(10) Requirement that coinsurance for covered part d drugs be based on the net price of the drug.—
“(A) In general.—For plan years beginning on or after January 1, 2026, for costs above the annual deductible specified in paragraph (1) and below the annual out-of-pocket threshold specified in paragraph
(4), any coinsurance amount for a covered part D drug (insofar as such covered part D drug is included on the formulary and subject to coinsurance rather than a copayment) shall be calculated based on the net price (and not the list price) of such covered part D drug if such net price is lower than the list price of such covered part D drug. The preceding sentence shall not apply to a covered part D drug described in paragraph
(8) or (9).
“(B) Net price defined.—In this paragraph, the term ‘net price’ means, with respect to a covered part D drug, the negotiated price of the covered part D drug under the prescription drug plan or MA-PD plan, net of any manufacturer-provided price concessions (as defined under section 423.100 of title 42, Code of Federal Regulations (or any successor regulation)), as reported for such drug in the Detailed DIR Report (or any successor report) submitted by the sponsor or organization offering the plan for the previous plan year.”.
(2) in subsection (c), by adding at the end the following new paragraph:
“(7) Requirement that coinsurance for covered part d drugs be based on the net price of the drug.—The coverage is provided in accordance with subsection (b)(10).”. <all>
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